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I Lot 1110. I Block I Ward _I AddUion or Replat
OUTSIDE WORK
Data
NEW SEwn WATER STORMS FEES FEES RELAY S. SEWER WATER STORMS fEES
From MaiD 10 Curb Seplic Tanks From Main 10 Curb
From CUl'b 10 BuDding Eleclric Pumps From CUl'b 10 BullclJng
Repair
INSIDE WORK
NO. NEW UP. USID FlES NO. NEW REP. USED FEES NO- NEW REP. USED FEES
~ - - ~
Batb Tub Gubage Dls~ Catch BolDs
f-----
Wuh Boin Dlsbwohen - ConducloTl
- ~ - ~
W- Clolel Laundzama.18 '" Greue Catch BolDs
SIDk Water SofIeneTl ¡ ~ 'f.-jJ Sump Pump 8< EjecioTl
Wa!8r Heaten sanUuy BubbleTl Bu and Soda Woles
Shower Bath8 UrlDats
n..... Dr8lna Denial Cuspidon
Laundry Tubo Service Sinks
IJllP8C!ions Valuation of Ihe Work Herein Described Fee VerUied. Receipled and Recorded Received PermU and Inspecllon Fees
-----------------------------------__----_Oulslde $--ç:jJþ._~-------------------------------------------------- n--------------------------Sewer Fees
---------------------------------------_----------Inslde ------,!--~----Plbg. Fees
------------------------------------------------ $------------------------------------------------------------------------- ---------I'--~----Tolal
----------------------.....E1Da1 OK $---------------------------------------------------------------------- --------------------------ë-i.¡T;;;;~;;;-------------------------- Dale ¥- /..1. 77
In the performance of this work the undersigned owner (or hi. authorirad agent) of .aid premi.e. and hi. authorired Plumber hereby agree to be bounden by and
submit to all .tatute.. city ordinances. and rule. and regul.tion. pre.cribed by the Boord of Public Work. for the government of Plumbers.
It I. futher agreed by the undersigned that no other uses will be mede of the above connectio
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